HCS 182 Entire Course

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 HCS/182

INTRODUCTION TO FINANCIAL CONCEPTS

 

The Latest Version A+ Study Guide

 

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HCS 182 Entire Course Link

https://uopcourses.com/category/hcs-182/

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HCS 182 Week 1 Financial Concepts Worksheet
 

Resource: Financial Concepts Worksheet

Complete Parts A and B of the Financial Concepts Worksheet.

Click the Assignment Files tab to submit your assignment.

Financial Concepts Worksheet

 

Part A: Match the appropriate term to its definition.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.
_____   Fee 

 
A.
The total amount a patient must pay on a covered medical expense.
2.
_____   Bad Debt 

 
B.
A summary of how the business incurs its revenues and expenses through both operating and non-operating activities.
3.
_____   Charge Master 

 
C.
A small amount of cash available for expenses such as postage, parking, fees, small contributions, emergency medical supplies, making change for patients, and small miscellaneous items.
4.
_____   Allowed Charges 

 
D.
The specific dollar amount charged by the healthcare entity or physician for each service offered.
5.
_____   Deductible 

 
E.
The maximum amount a payer will allow for each procedure.
6.
_____   Accounts Receivable 

 
F.
Daily record of financial transactions, including services rendered, charges, and receipts.
7
_____   Petty Cash Fund 

 
G.
The amount of medical encounter charges that is still outstanding.
8.
_____   Net Revenue 

 
H.
The part of the medical bill that must be written off because of billing arrangements with payer.
9.
_____   Contractual Adjustments 

 
I.
Accounts receivable that cannot be collected and are managed by either the allowance method or direct write-off.
10.
_____   Day Sheet 

 
J.
An obligation of an entity.
11.
_____   Balance Sheet 

 
K.
A list of procedures, services, supplies with associated charge.
12.
_____   Income Statement 

 
L.
Provides information about a company’s gross receipts and gross payments for a specified period of time.
13.
_____   Cash Flow Statements 

 
M.
Residual claimant or interest of investors in assets after all liabilities are paid.
14.
 _____   Assets 

 
N.
Tangible or intangible assets that can be owned, controlled, and produce a value.
15.
 _____   Liabilities 

 
O.
Snapshot of the company’s accounts at a single point in time.
16.
 _____   Equity 

 
P.
Amounts actually collected minus adjustment or discounts.
 

 

Part B:

 

Write a 90- to 175-word response to each of the following prompts. Format your answers according to APA guidelines and cite any sources accordingly.

 

 

 

 

 

Briefly explain the meaning of Assets = Liabilities + Owner’s Equity.
 

 

 

 

 

 

 

What are the three elements included in the end of day summary?
 

 

 

 
 

 

 

HCS 182 Week 1 Types of Accounting
 

Write a 525- to 700-word paper in which you identify types of accounting.

Include a table, diagram, or graphic comparing the cash basis method versus the accrual method.

Format your assignment according to APA guidelines.

Click the Assignment Files tab to submit your assignment.

 

 
 

 

 

HCS 182 Week 2 Insurance Structures and Contracting
 

Resource: Insurance Structures and Contracting Worksheet

Complete Parts A and B of the Insurance Worksheet.

Click the Assignment Files tab to submit your assignment.

Part A: Match the appropriate term to its definition.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.
_______  Point of Service Contract
A.
Review by insurance that grants approval for reimbursement of a health care service.
2.
_______  High Deductible Contract
B.
Reimbursement methods based on the number of individuals covered by the contract.
3.
_______  Capitation
C.
Patient insurance may stipulate a percentage of charges a patient must pay after reimbursement.
4.
_______  Health Savings Accounts
D.
Subscriber responsible for a large amount of health care costs during the year.
5.
_______  Copays and Deductibles
E.
Medicare regulations state a provider must refund a payment received from a patient for a service that is deemed by Medicare as unnecessary, experimental, or unapproved, unless the patient agrees to pay the provider in advance.
6.
_______  Gag Clause
F.
Gives tax-favored treatment for expenditures on health care cost. Enrollees of high deductible plans can save the money needed for health services.
7
_______  Preauthorization
G.
Special clauses in contract that stipulate additional coverage over and above the standard contract.
8.
_______  Coinsurance
H.
Amount of out-of-pocket costs a subscriber must pay each year for provider visits or procedures.
9.
_______  Rider
I.
Prevent providers from discussing all treatment options with patients; banned by Medicare and many states.
10.
_______  Medically necessary
J.
Subscribers can choose in-network or out-of-network provider.
 

Part B: It is no secret that patients ask many questions about their insurance. In fact, many will assume the doctor’s office knows everything about insurance. Understanding various insurance structures will give you the tools needed to assist your patients. In the following scenarios, you are answering the phone at a health care center and patients are calling with insurance questions.

 

Write a 90- to 175-word response to each of the following questions. Format your answers according to APA guidelines and cite any sources accordingly.

 

 

 

 

 

Jones calls the office and explains, “It is open enrollment and my employer is offering us a choice between a PPO plan and an HMO plan. Can you tell me the difference between them and which one you would recommend?”
 

 

 

 

 

 

Mary calls the office and asks, “I am so confused. Can you please help me understand the difference between an EPO and a POS plan? Everyone at work is asking, and I know you would be able to tell me.”
 

 

 

 

 

 

John calls the office and asks, “I was laid off and cannot afford the COBRA plan from my employer, but my insurance agent said an indemnity plan would be affordable. Can you tell me about this indemnity plan?”
 

 

 

 

 

 

Thomas calls the office and asks, “My employer is offering us cafeteria plans for next year, and I know this means I basically build my own plan, but could you tell me, of the PPO, HMO, or traditional comprehensive plan, which one or ones will enable me to go out-of-network for care? I do quite a bit of traveling and this concerns me.”
 

 

 

 

 

 

HCS 182 Week 2 Sources of Health Care Revenue
 

Health care entities rely on reimbursement from various sources to generate revenue for the organization. This is typically achieved through the billing process.

Write a 525- to 700-word paper in which you:

 

 

 

Identify sources of health care revenue.
 

 

Identify which sources are government sponsored.
 

 

Explain how inappropriate billing can lead to fraud.
 

 

Explain the consequences of fraudulent activity.
 

 

Explain how to report Medicare and Medicaid fraud.
 

 

Format your assignment according to APA guidelines.

Click the Assignment Files tab to submit your assignment.

 

 
 

 

 

HCS 182 Week 3 Health Care Billing
 

Resource: Health Care Billing Worksheet

Complete Parts A, B, and C of the Health Care Billing Worksheet.

Click the Assignment Files tab to submit your assignment.

Part A: Match the appropriate term to its definition.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.
_______  Provider Liability for 

Overpayments
A.
Mandated to find and correct improper Medicare payments made to providers.
2.
_______  Medicare Share Savings
B.
Medicare providers responsible for overpayment for claims that do not meet medical necessity, correct coding initiatives, or have documentation to support codes reported on claims.
3.
_______  Recovery Audit Contractors
C.
Medicare program introduced in 1996 to reduce expenditures due to inappropriate codes submitted on claims.
4.
_______  Medicaid Integrity Program
D.
Ensure the availability of records for governmental and other third-party agencies, time mandated by federal or state regulations.
5.
_______  HIPAA
E.
Provides funds to combat fraud, waste, and abuse of those providers seeking reimbursement from Medicaid.
6.
_______  Retention of Records
F.
Program to facilitate coordination and cooperation to improve the quality of care for Medicare fee-for-service beneficiaries.
7
_______  National Correct Coding 

Initiative
G.
Provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information.
 

 

Part B: Match the appropriate term to its definition.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.
_______  Evaluation and Management Codes
A.
Includes physician work, practice expenses, and malpractice cost.
2.
_______   Modifiers
B.
Used in most evaluation and management and CPT codes to describe a patient visit and level of complexity of the visit.
3.
_______   Levels of Coding Key 

Components
C.
Two-digit codes added to the five digit CPT codes to further define the service procedure.
4.
_______   ICD-10-PCS Codes
D.
Used for office and outpatient services.
5.
_______   Relative Value Unit
E.
Used to code medical necessity.
6.
_______   Revenue Codes
F.
A document sent to the patient and provider from the insurance payor that explains how the reimbursement amount for services is determined.
7.
_______   Explanation of Benefits
G.
An explanation of benefits document that is sent to the physician. It is a complete summary of all benefits paid to a provider for services completed for patients during a certain period of time.
8.
_______   Remittance Advice
H.
Health care given to low income patients for free or at a reduced rate.
9.
_______   Write-Off
I.
The part of a charge that is eventually paid by no one.
10.
_______   Contractual Allowance
J.
Amount of a charge is not allowed the insurance payor.
11.
_______   Charity Care
K.
Used to code hospital inpatient treatments and services.
12.
_______   ICD-10-CM
L.
A four-digit code on a facility’s charge master to indicate the location or type of service provided to an institutional patient.
 

 

Part C: Read the following scenarios and answer the questions that follow.

 

 

 

 

Mary presents her BCBS card to the office, which indicates that she has a $20.00 copay. The charges for her services that day are $120.00 for an office visit. How much should be collected at the time of service?
 

 

 

 

 

 

Sherrie needs to balance her cash drawer to complete the end of day close process. Her day sheet totals are as follows:
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Patient Name
Charges
Payment Type
Amount Paid
Anticipated Insurance Balance
Patient Balance
Joe Disney
150.00
Cash
25.00
125.00
0
Angela Murray
50.00
Visa
10.00
40.00
0
Shawna Johnson
300.00
Check
25.00
200.00
75.00
Misty Smith
500.00
Check
80.00
420.00
0
Kevin Gold
325.00
Visa
325.00
0
0
Robert Lane
775.00
Cash
75.00
600
25.00
Thomas Newman
185.00
American Express
85.00
0.00
100.00
Patricia Gorman
72.00
MasterCard
0.00
72.00
0.00
Alice Orange
433.00
Cash
162.00
200
71.00
TOTALS
 
 
 
 
 
 

 

 

 

 

What are the total cash payments?
 

 

 

 

 

 

What are the total charges for the day?
 

 

 

 

 

 

What are the total Credit Card Payments for the day?
 

 

 

 

 

 

What is the total amount of receivables due for the day? What amount is patient and what amount is anticipated insurance?
 

 

 

 

 

 

Fill in the TOTALS for each column in the table above.
 

 

 

 
 

 

 

HCS 182 Week 3 Signature Assignment: Front Office Employee Training, Part 1
 

Health care administrators, managers, medical office administrative assistants, and coders need to be familiar with the medical business office operation and what factors have an impact on the daily operations of a medical facility.

Imagine you work for a consulting company and have been asked by a medical outpatient office (such as a family practice or specialty office) to conduct two training sessions for new front office employees. Many of the new staff are also new to health care. The first session will be about “Front Office Business Procedures”.

Create a 7- to 9-slide Microsoft® PowerPoint® presentation with detailed speaker notes in which you discuss the following:

 

 

 

Identify sources of health care revenue.
 

 

Compare insurance structures.
 

 

Identify rules and regulations governing patient billing.
 

 

Identify processes associated with the medical revenue cycle.
 

 

Format your presentation according to APA guidelines.

Cite 2 peer-reviewed, scholarly, or similar references to support your presentation. All references should be in APA format within your speaker notes and at the end of your presentation. You should also cite any graphics from other sources used in your slides.

Click the Assignment Files tab to submit your assignment.

 

 
 

 

 

HCS 182 Week 4 The Claims Process
 

Resources: Claims Process Worksheet, CMS 1500 Claim Form

Complete parts A, B, and C of the Claims Process Worksheet.

Click the Assignment Files tab to submit the Claims Process worksheet and the CMS 1500 Claim Form.

Part A: Read the following scenario:

 

Mrs. Jane Sample (DOB 12/22/1967) called her primary care provider’s office and scheduled an appointment with Dr. Billings for Monday, October 22nd, 2015. She requested the appointment because she had a cough and some congestion as well as wheezing and a fever off and on for about three days prior. Upon registration, she informed the front desk that she had new insurance effective October 1, 2015.

 

The insurance card was scanned and the following information was verified:

 

 

 

Name: Jane Sample
 

 

DOB 12/22/1967
 

 

Address: 211 First Lane
 

 

 Houston, TX 77398

 

 

 

Phone Number: (555) 727-5555
 

 

Insurance Subscriber: John Sample  

 

 

 

DOB: 5/25/1965
 

 

 
 

 

 

The doctor examined Mrs. Sample and felt that due to the wheezing, a chest X-ray was needed to determine if pneumonia was present. This patient has had a history of pneumonia, so it was medically necessary to evaluate the present signs and symptoms. The chest X-ray did reveal left lobe pneumonia.

 

Mrs. Sample was given prescriptions for Erythromycin 500mg three times daily, Prednisone 5mg once daily, and Tessalon Pearls as needed for cough every four hours.

 

Dr. Billings filled out the encounter form with the following information:

 

 

 

Office Visit level of service: 99214   Charges: 150.00
 

 

Chest xray: 71020   Charges: 125.00
 

 

Diagnosis: Left Lower Lobe Pneumonia  J18.1
 

 

Ralph Billings MD
 

 

777 Smith Avenue
 

 

Houston, TX 77398
 

 

Phone (555) 555-5555
 

 

NPI: 1234567891
 

 

 

Part B: Mrs. Sample indicated that her insurance was new as of October 1st. Looking at the card below, please answer the following:

 

 

 

 

Who is the subscriber
 

 

 

 

 

 

What is the group number?
 

 

 

 

 

 

What is the Identification number?
 

 

 

 

 

 

What is the type of Taylor plan?
 

 

 

 

 

 

What is the claim’s address?
 

 

 

 

 

 

What is the copay listed for PCP?
 

 

 

 

Part C: Collecting accurate claim’s data ensures the likelihood of creating a clean claim. Using the information in the scenario in Part A, open the CMS_1500_Claim_Form and fill in the following fields of the 1500 claim form:

 

 

 

Sections 1-11
 

 

Section 21
 

 

Section 24: lines 1 and 2
 

 

Section 28
 

 

Section 33
 

 

 

 
 

 

 

HCS 182 Week 4 The Appeals Process
 

Resource: Appeals Process Scenario, Appeals Process Template

Read the Appeals Process Scenario document.

Write a 350- to 525-word letter of appeal to Taylor Insurance and explain why you are asking for reconsideration. Use the Appeal Letter template to create your correspondence.

Format your assignment according to APA guidelines.

Click the Assignment Files tab to submit your assignment.

 

 
 

 

 

HCS 182 Week 5 Bookkeeping
 

Resource: Bookkeeping Worksheet

Complete Parts A, B, and C of the Bookkeeping Worksheet.

Click the Assignment Files tab to submit your assignment.

Part A: Match the appropriate term to its definition.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.
_____    Medical Service Charge 

 Fee

 
A.
Occurs when patient makes payment on the charges for the service delivered.
2.
_____    Posting a Payment 

 
B.
Measures collection period of receivables.
3.
_____    Contractual Adjustment 

 
C.
Reimbursing the patient for an overpayment of the charges for the services previously delivered.
4.
_____    Bad Debt Write-Off 

 
D.
Write-off can be done with either allowance method or direct method.
5.
_____    Payment Refund 

 
E.
After a patient’s diagnosis occurs, the patient account must be updated based on the fee for the service.
6.
_____    End of Day Summary 

 
F.
Document consisting of proof of posting sections, month to date accounts receivable proof, and year to date accounts receivable proof.
7
_____    Relative Value Unit 

 
G.
Portion of the patient’s bill that must be written off because of billing agreements with an insurance company.
8.
_____    Average Charge per 

Procedure

 
H.
The percentage rate of claims denied for private insurance versus government insurance versus self-paying individuals for a provider.
9.
_____    Net Charges 

 
I.
The percentage of revenue coming from private insurance versus government insurance versus self-paying individuals for a provider.
10.
_____    Average AR Days 

Outstanding

 
J.
Are payments a provider has agreed to accept from payers for the services provided.
11.
_____    Payer Mix 

 
K.
Average cost of a certain medical procedure.
12.
_____    Payer Denial Rate 

 
L.
A measure of value used in the United States Medicare reimbursement formula for physician services.
 

 

Part B:

 

Read the following scenario then use the data and formulas below to calculate the Gross Collections Rate, Net Collections Rate, and Average AR Days Outstanding.

 

John is preparing for the quarterly financial meeting and must present the current figures to the providers of Sunshine Family Healthcare. John has asked you to help him with this task and wants you review the data below and calculate values needed for his presentation.

 

For the Quarter

Total Charges: 750,000

Total Collections: 525,000

Accounts Receivables: 85,000

Net Charges: 435,000

 

 

 

 

Total Collections / Totals Charges = Gross Collections Rate
 

 

 

 

 

 

 

Net Charges / Total Collections = Net Collections Rate
 

 

(net charges are payments a provider has agreed to accept from payers for the services provided)

 

 

 

 

 

Accounts Receivables / (Total Charges / 365) = Average AR Days Outstanding
 

 

(measures collection period of receivables)

 

 

Part C: 

 

Write a 90- to 175-word response to each of the following prompts:

 

 

 

 

 

Identify various posting actions included in a medical office.
 

 

 

 

 

 

 

Explain the importance of reconciling financial statements.
 

 

 

 

 

 

 

Explain the importance of petty cash management.
 

 

 

 

 
 

 

 

HCS 182 Week 5 Signature Assignment: Front Office Employee Training, Part 2
 

The revenue cycle begins with registration, where accurate data must be captured to process claims efficiently. Reimbursement for services can be collected in a timely manner when processes are effective. Medical office administrators, managers, and medical office administrative assistants need to have knowledge of how encounter data is transitioned to claims and what factors can affect claim processing from beginning to end, whether payment is received or a claim follow-up is needed.

Imagine you are returning to the medical office to conduct the last training session.

Create a 7- to 9-slide Microsoft® PowerPoint® presentation with detailed speaker notes in which you discuss the following:

 

 

 

Explain how to report insurance fraud.
 

 

Compare uses of coding.
 

 

Explain claim submission processes.
 

 

Identify appropriate follow-up to claims.
 

 

Format your presentation according to APA guidelines.

Cite 2 peer-reviewed, scholarly, or similar references to support your presentation. All references should be in APA format within your speaker notes and at the end of your presentation. You should also cite any graphics from other sources used in your slides.

Click the Assignment Files tab to submit your assignment.
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